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Semin intervent Radiol 2021; 38(03): 291-299
DOI: 10.1055/s-0041-1731087
Review Article

Percutaneous Management of Benign Biliary Strictures

Adam Fang
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Il Kyoon Kim
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Ifechi Ukeh
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Vahid Etezadi
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Hyun S. Kim
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract

Benign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.

Keywords

interventional radiology - benign biliary strictures - percutaneous management - cholangioplasty - biliary stent


Publication History

Article published online:
10 August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Tummala P, Munigala S, Eloubeidi MA, Agarwal B. Patients with obstructive jaundice and biliary stricture  ± mass lesion on imaging: prevalence of malignancy and potential role of EUS-FNA. J Clin Gastroenterol 2013; 47 (06) 532-537
    CrossrefPubMedGoogle Scholar
  • 2 Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13 (01) 28-37
    CrossrefPubMedGoogle Scholar
  • 3 Mariani A, Segato S, Anderloni A. et al. Prospective evaluation of ERCP performance in an Italian regional database study. Dig Liver Dis 2019; 51 (07) 978-984
    CrossrefPubMedGoogle Scholar
  • 4 Ekkelenkamp VE, de Man RA, Ter Borg F. et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47 (06) 503-507
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50 (09) 910-930
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Judah JR, Draganov PV. Endoscopic therapy of benign biliary strictures. World J Gastroenterol 2007; 13 (26) 3531-3539
    CrossrefPubMedGoogle Scholar
  • 7 Koide H, Sato K, Fukusato T. et al. Spontaneous regression of hepatic inflammatory pseudotumor with primary biliary cirrhosis: case report and literature review. World J Gastroenterol 2006; 12 (10) 1645-1648
    CrossrefPubMedGoogle Scholar
  • 8 Op den Dries S, Sutton ME, Lisman T, Porte RJ. Protection of bile ducts in liver transplantation: looking beyond ischemia. Transplantation 2011; 92 (04) 373-379
    CrossrefPubMedGoogle Scholar
  • 9 Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001; 25 (10) 1241-1244
    CrossrefPubMedGoogle Scholar
  • 10 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180 (01) 101-125
    PubMedGoogle Scholar
  • 11 Kapoor BS, Mauri G, Lorenz JM. Management of biliary strictures: state-of-the-art review. Radiology 2018; 289 (03) 590-603
    CrossrefPubMedGoogle Scholar
  • 12 Fidelman N. Benign biliary strictures: diagnostic evaluation and approaches to percutaneous treatment. Tech Vasc Interv Radiol 2015; 18 (04) 210-217
    CrossrefPubMedGoogle Scholar
  • 13 Blackbourne LH, Earnhardt RC, Sistrom CL, Abbitt P, Jones RS. The sensitivity and role of ultrasound in the evaluation of biliary obstruction. Am Surg 1994; 60 (09) 683-690
    PubMedGoogle Scholar
  • 14 Choi SH, Han JK, Lee JM. et al. Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology 2005; 236 (01) 178-183
    CrossrefPubMedGoogle Scholar
  • 15 Yoon KH, Ha HK, Kim MH. et al. Biliary stricture caused by blunt abdominal trauma: clinical and radiologic features in five patients. Radiology 1998; 207 (03) 737-741
    CrossrefPubMedGoogle Scholar
  • 16 Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging 2012; 3 (01) 11-21
    CrossrefPubMedGoogle Scholar
  • 17 Suthar M, Purohit S, Bhargav V, Goyal P. Role of MRCP in differentiation of benign and malignant causes of biliary obstruction. J Clin Diagn Res 2015; 9 (11) TC08-TC12
    PubMedGoogle Scholar
  • 18 Soto JA, Alvarez O, Lopera JE, Múnera F, Restrepo JC, Correa G. Biliary obstruction: findings at MR cholangiography and cross-sectional MR imaging. Radiographics 2000; 20 (02) 353-366
    CrossrefPubMedGoogle Scholar
  • 19 Lee SS, Kim MH, Lee SK. et al. MR cholangiography versus cholangioscopy for evaluation of longitudinal extension of hilar cholangiocarcinoma. Gastrointest Endosc 2002; 56 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 20 Fulcher AS, Turner MA. HASTE MR cholangiography in the evaluation of hilar cholangiocarcinoma. AJR Am J Roentgenol 1997; 169 (06) 1501-1505
    CrossrefPubMedGoogle Scholar
  • 21 Materne R, Van Beers BE, Gigot JF. et al. Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 2000; 32 (01) 3-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 2014; 20 (30) 10495-10503
    CrossrefPubMedGoogle Scholar
  • 23 Funaki B. Percutaneous biliary drainage. Semin Intervent Radiol 2007; 24 (02) 268-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33 (04) 283-290
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Altman A, Zangan SM. Benign biliary strictures. Semin Intervent Radiol 2016; 33 (04) 297-306
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Ahmed S, Schlachter TR, Hong K. Percutaneous transhepatic cholangioscopy. Tech Vasc Interv Radiol 2015; 18 (04) 201-209
    CrossrefPubMedGoogle Scholar
  • 27 Qin LX, Tang ZY. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis. World J Gastroenterol 2003; 9 (03) 385-391
    CrossrefPubMedGoogle Scholar
  • 28 Ponchon T, Genin G, Mitchell R. et al. Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures. Ann Surg 1996; 223 (01) 26-36
    CrossrefPubMedGoogle Scholar
  • 29 Wieman TJ, Corey TS, Shively E. Postoperative percutaneous choledochoscopy. Am Surg 1989; 55 (02) 97-99
    PubMedGoogle Scholar
  • 30 Zhuo H, Chen Z, Lin R. et al. Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis. Surg Laparosc Endosc Percutan Tech 2020; 31 (03) 326-330
    CrossrefPubMedGoogle Scholar
  • 31 Hazey JW, McCreary M, Guy G, Melvin WS. Efficacy of percutaneous treatment of biliary tract calculi using the holmium:YAG laser. Surg Endosc 2007; 21 (07) 1180-1183
    CrossrefPubMedGoogle Scholar
  • 32 Ma MX, Jayasekeran V, Chong AK. Benign biliary strictures: prevalence, impact, and management strategies. Clin Exp Gastroenterol 2019; 12: 83-92
    CrossrefPubMedGoogle Scholar
  • 33 Gwon DI, Ko GY, Ko HK, Yoon HK, Sung KB. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci 2013; 58 (11) 3270-3279
    CrossrefPubMedGoogle Scholar
  • 34 Tocchi A, Mazzoni G, Liotta G. et al. Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting. Arch Surg 2000; 135 (02) 153-157
    CrossrefPubMedGoogle Scholar
  • 35 Genest JF, Nanos E, Grundfest-Broniatowski S, Vogt D, Hermann RE. Benign biliary strictures: an analytic review (1970 to 1984). Surgery 1986; 99 (04) 409-413
    PubMedGoogle Scholar
  • 36 Röthlin MA, Löpfe M, Schlumpf R, Largiadèr F. Long-term results of hepaticojejunostomy for benign lesions of the bile ducts. Am J Surg 1998; 175 (01) 22-26
    CrossrefPubMedGoogle Scholar
  • 37 Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 2001; 33 (05) 409-415
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Way LW, Bernhoft RA, Thomas MJ. Biliary stricture. Surg Clin North Am 1981; 61 (04) 963-972
    CrossrefPubMedGoogle Scholar
  • 39 Shanbhogue AK, Tirumani SH, Prasad SR, Fasih N, McInnes M. Benign biliary strictures: a current comprehensive clinical and imaging review. AJR Am J Roentgenol 2011; 197 (02) W295-W306
    CrossrefPubMedGoogle Scholar
  • 40 De Robertis R, Contro A, Zamboni G, Mansueto G. Totally percutaneous rendezvous techniques for the treatment of bile strictures and leakages. J Vasc Interv Radiol 2014; 25 (04) 650-654
    CrossrefPubMedGoogle Scholar
  • 41 Habibollahi P, Benjamin JL, Bai HX, Dagli MS, Shlansky-Goldberg RD. Percutaneous fluoroscopic-guided creation of neoanastomosis for the treatment of biliary occlusions. Cardiovasc Intervent Radiol 2020; 43 (11) 1671-1678
    CrossrefPubMedGoogle Scholar
  • 42 Ludwig JM, Webber GR, Knechtle SJ, Spivey JR, Xing M, Kim HS. Percutaneous management of benign biliary strictures with large-bore catheters: comparison between patients with and without orthotopic liver transplantation. J Vasc Interv Radiol 2016; 27 (02) 219-225.e1
    CrossrefPubMedGoogle Scholar
  • 43 DePietro DM, Shlansky-Goldberg RD, Soulen MC. et al. Long-term outcomes of a benign biliary stricture protocol. J Vasc Interv Radiol 2015; 26 (07) 1032-1039
    CrossrefPubMedGoogle Scholar
  • 44 Weber A, Rosca B, Neu B. et al. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy 2009; 41 (04) 323-328
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Eickhoff A, Schilling D, Jakobs R. et al. Long-term outcome of percutaneous transhepatic drainage for benign bile duct stenoses. Rocz Akad Med Bialymst 2005; 50: 155-160
    PubMedGoogle Scholar
  • 46 Gwon DI, Sung KB, Ko GY, Yoon HK, Lee SG. Dual catheter placement technique for treatment of biliary anastomotic strictures after liver transplantation. Liver Transpl 2011; 17 (02) 159-166
    CrossrefPubMedGoogle Scholar
  • 47 Park SJ, Chung HH, Lee SH. et al. Long-term balloon indwelling technique for the treatment of single benign biliary stricture. Diagn Interv Radiol 2019; 25 (01) 90-94
    CrossrefPubMedGoogle Scholar
  • 48 Zajko AB, Sheng R, Zetti GM, Madariaga JR, Bron KM. Transhepatic balloon dilation of biliary strictures in liver transplant patients: a 10-year experience. J Vasc Interv Radiol 1995; 6 (01) 79-83
    CrossrefPubMedGoogle Scholar
  • 49 Krokidis M, Orgera G, Rossi M, Matteoli M, Hatzidakis A. Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Insights Imaging 2013; 4 (01) 77-84
    CrossrefPubMedGoogle Scholar
  • 50 Köcher M, Cerná M, Havlík R, Král V, Gryga A, Duda M. Percutaneous treatment of benign bile duct strictures. Eur J Radiol 2007; 62 (02) 170-174
    CrossrefPubMedGoogle Scholar
  • 51 Glas L, Courbière M, Ficarelli S, Milot L, Mennesson N, Pilleul F. Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. J Vasc Interv Radiol 2008; 19 (09) 1336-1343
    CrossrefPubMedGoogle Scholar
  • 52 Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 2012; 203 (06) 675-683
    CrossrefPubMedGoogle Scholar
  • 53 Kucukay F, Okten RS, Yurdakul M. et al. Long-term results of percutaneous biliary balloon dilation treatment for benign hepaticojejunostomy strictures: are repeated balloon dilations necessary?. J Vasc Interv Radiol 2012; 23 (10) 1347-1355 , quiz 1357
    CrossrefPubMedGoogle Scholar
  • 54 Ko GY, Sung KB, Yoon HK, Kim KR, Gwon DI, Lee SG. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transpl 2008; 14 (09) 1323-1332
    CrossrefPubMedGoogle Scholar
  • 55 Vos PM, van Beek EJ, Smits NJ, Rauws EA, Gouma DJ, Reeders JW. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom Imaging 2000; 25 (02) 134-138
    CrossrefPubMedGoogle Scholar
  • 56 Atar E, Bachar GN, Bartal G. et al. Use of peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures. J Vasc Interv Radiol 2005; 16 (2, Pt 1): 241-245
    CrossrefPubMedGoogle Scholar
  • 57 Saad WE, Saad NE, Davies MG. et al. Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery. J Vasc Interv Radiol 2005; 16 (09) 1221-1228
    CrossrefPubMedGoogle Scholar
  • 58 Siriwardana HP, Siriwardena AK. Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture. Ann Surg 2005; 242 (01) 10-19
    CrossrefPubMedGoogle Scholar
  • 59 Kim JH, Gwon DI, Ko GY. et al. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol 2011; 22 (06) 893-899
    CrossrefPubMedGoogle Scholar
  • 60 Schmidt A, Pickartz T, Lerch MM. et al. Effective treatment of benign biliary strictures with a removable, fully covered, self-expandable metal stent: a prospective, multicenter European study. United European Gastroenterol J 2017; 5 (03) 398-407
    CrossrefPubMedGoogle Scholar
  • 61 Yun G, Yoon CJ, Seong NJ. Percutaneous treatment of benign bilioenteric anastomotic strictures: temporary covered stent placement versus balloon dilatation. Eur Radiol 2019; 29 (05) 2690-2697
    CrossrefPubMedGoogle Scholar
  • 62 Ye P, Zeng Q, Miao H, Pang H, Chen Y. Percutaneous treatment of benign biliary anastomotic strictures: retrievable covered self-expandable metal stent with fixation string versus large-bore catheters. J Vasc Interv Radiol 2021; 32 (01) 113-120
    CrossrefPubMedGoogle Scholar
  • 63 Riaz A, Entezari P, Ganger D. et al. Percutaneous access of the modified Hutson loop for retrograde cholangiography, endoscopy, and biliary interventions. J Vasc Interv Radiol 2020; 31 (12) 2113-2120.e1
    CrossrefPubMedGoogle Scholar
  • 64 Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 2001; 54 (02) 162-168
    CrossrefPubMedGoogle Scholar
  • 65 Draganov P, Hoffman B, Marsh W, Cotton P, Cunningham J. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest Endosc 2002; 55 (06) 680-686
    CrossrefPubMedGoogle Scholar
  • 66 Coté GA, Slivka A, Tarnasky P. et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA 2016; 315 (12) 1250-1257
    CrossrefPubMedGoogle Scholar
  • 67 Mauri G, Michelozzi C, Melchiorre F. et al. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 2016; 26 (11) 4057-4063
    CrossrefPubMedGoogle Scholar
  • 68 Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27 (02) 239-249
    CrossrefPubMedGoogle Scholar
  • 69 Akinci D, Unal E, Ciftci TT, Kyendyebai S, Abbasoglu O, Akhan O. Endobiliary radiofrequency ablation in the percutaneous management of refractory benign bilioenteric anastomosis strictures. AJR Am J Roentgenol 2019; 212 (03) W83-W91
    CrossrefPubMedGoogle Scholar
  • 70 De Gregorio MA, Criado E, Guirola JA. et al; Spanish Group BiELLA (SERVEI). Absorbable stents for treatment of benign biliary strictures: long-term follow-up in the prospective Spanish registry. Eur Radiol 2020; 30 (08) 4486-4495
    CrossrefPubMedGoogle Scholar
  • 71 Jang SI, Kim JH, Won JY. et al. Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. Gastrointest Endosc 2011; 74 (05) 1040-1048
    CrossrefPubMedGoogle Scholar
  • 72 Parlak E, Koksal AS, Kucukay F, Eminler AT, Toka B, Uslan MI. A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis. Gastrointest Endosc 2017; 85 (04) 841-847
    CrossrefPubMedGoogle Scholar
  • 73 Li Y, Sun H, Yan X. et al. Magnetic compression anastomosis for the treatment of benign biliary strictures: a clinical study from China. Surg Endosc 2020; 34 (06) 2541-2550
    CrossrefPubMedGoogle Scholar
  • 74 Avaliani M, Chigogidze N, Nechipai A, Dolgushin B. Magnetic compression biliary-enteric anastomosis for palliation of obstructive jaundice: initial clinical results. J Vasc Interv Radiol 2009; 20 (05) 614-623
    CrossrefPubMedGoogle Scholar
  • 75 Li TF, Huang GH, Li Z. et al. Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction. J Vasc Interv Radiol 2015; 26 (05) 715-721
    CrossrefPubMedGoogle Scholar
  • 76 Mizandari M, Pai M, Xi F. et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2013; 36 (03) 814-819
    CrossrefPubMedGoogle Scholar
  • 77 Pai M, Valek V, Tomas A. et al. Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2014; 37 (01) 235-240
    CrossrefPubMedGoogle Scholar
  • 78 Hu B, Gao DJ, Wu J, Wang TT, Yang XM, Ye X. Intraductal radiofrequency ablation for refractory benign biliary stricture: pilot feasibility study. Dig Endosc 2014; 26 (04) 581-585
    CrossrefPubMedGoogle Scholar
  • 79 Saad WE, Davies MG, Saad NE. et al. Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy. J Vasc Interv Radiol 2006; 17 (05) 837-843
    CrossrefPubMedGoogle Scholar
  • 80 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4 (03) 200-206
    CrossrefPubMedGoogle Scholar
  • 81 Burke DR, Lewis CA, Cardella JF. et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 2003; 14 (9, Pt 2): S243-S246
    PubMedGoogle Scholar